| Doctor Name: | THOMAS S. SULLIVAN |
| NPI Number: | 1477547933 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.S., R.PH., BCNSP |
| License Number: | 5302025761 |
| Business Practice Address: | 159 Kercheval Ave Grosse Pointe Farms, MI - 482363610 |
| Business Phone Number: | 3136402385 |
| Business Fax Number: | 3133438657 |
| Mailing Address: | 1234 Harvard Rd, GROSSE POINTE PARK |
| State: | MI |
| Postal Code: | 482301132 |
| Phone Number: | 3133431646 |
| Fax Number: | 3133431184 |
| NPI Enumeration Date: | 09/09/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1835N1003X |
| License Number: | 5302025761 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacist |
| Taxonomy Specialization: | Nutrition Support |
| Taxonomy Definition: | A licensed pharmacist who has demonstrated specialized knowledge and skill in maintenance and/or restoration of optimal nutritional status, designing and modifying treatment according to patient needs. |